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Validation of Songklanagarind Pediatric Triage Model in the Emergency Department; a Cross-Sectional Study
Siriwimon Tantarattanapong1, Nut Chonwanich1, Wannipha Senuphai2
1Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Insights
The Songklanagarind Pediatric Triage (SPT) model shows good accuracy in predicting hospital admission and resource use for pediatric patients. Further refinement is needed to reduce over- and under-triage rates in emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Triage Systems
Background:
- Effective pediatric triage in emergency departments (EDs) requires robust protocols, experienced nurses, and consideration of patient-specific factors.
- Existing triage tools may not fully capture the complexities of pediatric emergencies, necessitating validated models.
- The Songklanagarind Pediatric Triage (SPT) model was developed to address these needs in a tertiary care setting.
Purpose of the Study:
- To evaluate the validity and accuracy of the newly developed Songklanagarind Pediatric Triage (SPT) model.
- To identify clinical factors associated with the appropriateness of pediatric triage decisions in the ED.
- To assess the correlation of SPT levels with hospital admission and resource utilization.
Main Methods:
- Phase 1: Development of the SPT model by integrating elements from established tools (ESI, PAT, PaedCTAS) and a pediatric septic shock protocol.
- Phase 2: Prospective observational study of 520 pediatric patients in the ED of a tertiary university hospital in Thailand.
- Evaluation of SPT's sensitivity, specificity, and predictive values for critical outcomes; analysis of factors influencing triage appropriateness.
Main Results:
- The SPT model demonstrated high sensitivity (98.28%) and negative predictive value (98.15%) for predicting death, hospitalization, and resource utilization.
- Appropriate triage, over-triage, and under-triage rates were 68.8%, 28.5%, and 2.7%, respectively.
- Factors significantly associated with triage appropriateness included respiratory conditions, fever, dyspnea, diarrhea, oxygen saturation, accessory muscle use, and wheezing/rhonchi.
Conclusions:
- The SPT model shows a strong correlation with hospital admission rates and resource utilization in pediatric patients.
- While effective, the model requires further refinement to minimize rates of over- and under-triage.
- Identifying specific clinical indicators can aid in improving the accuracy of pediatric emergency triage.
Introduction:
An effective triage needs to consider many factors, such as good triage protocol, experienced triage nurses, and patient factors. This study aimed to evaluate the validity of Songklanagarind Pediatric Triage (SPT) for triage of pediatric patients in the emergency department (ED) and identify the factors associated with triage appropriateness.
Methods:
This study was done in two phases. In the first phase, a team of emergency physicians, a pediatric emergency physician, and a pediatric critical care physician developed SPT model by considering and combining Emergency Severity Index (ESI), Pediatric Assessment Triangle (PAT), Pediatric Canadian Triage and Acuity Scale (PaedCTAS), and Pediatric Septic Shock early warning signs protocol of the hospital as the core concept. In the second phase, a prospective observational study was conducted in the ED of Songklanagarind Hospital, which is a tertiary university hospital in southern Thailand, from September to October 2019 to evaluate the accuracy of the developed triage model.
Results:
A total of 520 pediatric patients met the inclusion criteria. The pediatric triage model had sensitivity and specificity values of 98.28% and 26.24%, respectively, and positive and negative predictive values of 27.67% and 98.15%, respectively, in prediction of death, hospitalization, and resource utilization. The rates of appropriate triage, over-triage, and under-triage were 68.8%, 28.5%, and 2.7%, respectively. Significant factors associated with appropriateness of triage were underlying disease of the respiratory system (OR = 4.16, 95%CI: 1.75‒9.23), fever (OR = 0.60, 95%CI: 0.41‒0.88), dyspnea (OR: 6.38, 95%CI: 2.51‒16.22), diarrhea (OR = 0.26, 95%CI: 0.09‒0.73), oxygen saturation <95% (OR = 3.18, 95%CI: 1.09‒9.27), accessory muscle use during breathing (OR = 3.67, 95%CI: 1.09‒12.41), and wheezing or rhonchi (OR = 6.96, 95%CI: 3.14‒15.43).
Conclusion:
SPT showed good correlation of hospital admission rates and resource utilization with pediatric triage level of urgency. However, further efforts are needed to decrease the rates of over- and under-triage.
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